Multi-criteria decision-making
Given such challenges, other options to enhance clinical decision-making
have been proposed. One option is multi-criteria decision-making (MCDM)
analysis,13-15 which could potentially be used to
improve consistency, reliability, and the efficiency of clinical
decision-making in an evidence-based method.
MCDM analysis can be a means to quantify clinical subjective information
and formalise decision-making. When clinically interpreting multiple
pieces of subjective information, this information can become more
explicit and transparent if structured into an ordered form using
decision-making tools. MCDM analysis has the additional benefit of using
mathematical modelling with ranking and scoring, to refine and provide
decision-making structure. Having structure and ranking of important
clinical information supports the clinician with decision-making which
is a step up from (potentially flawed) clinical
intuition.16
The design of a model is beyond the scope of this report. However, we
can briefly consider the steps using the example of a clinical provider
undertaking decision-making from a musculoskeletal assessment. When
mathematical modelling is added to this scenario, as in MCDM analysis,
multiple subjective pieces of clinical information can be developed into
a set of decision-making factors called criteria, which in turn have
levels of choices. The levels of choices have a point value, that can
represent their relative importance,13 and there is
available software that can be used to attribute point values to the
refined clinical information.17 The point values give
a clear representation of the relative importance of each piece of
clinical information to allow alternatives to be
compared.18 This allows transparency, reliability, and
credibility for the decision-making process. While there are many
different MCDM models, they all aim is to improve
decision-making.19 Although, to date, MCDM is not
being used for shoulder injury pathway decision-making, there are many
areas in healthcare where MCDM has been used successfully, such as
prioritising antibiotics, recommending hip tests and classifying
disease.20-22
When considering the basic MCDM, and what makes this a possible
solution, it is helpful to have some history. MCDM has been developing
for over 40 years23 and for health care, the use of
MCDM analysis is steadily growing.15 It is important
to recognise that in health care, algorithms and point systems have long
been used as a source of assisting decision-making and there is
increasing support for algorithms for more complex decisions, such as
prioritising for elective surgery13 With an increasing
prevalence of musculoskeletal conditions as the population ages, this is
an area where MCDM tools can be useful to guide
decision-making.24 MCDM tools are used online, and the
process of using internet-based software for health decision-making has
been found acceptable for both health care providers and
patients.13 Furthermore, online MCDM software is a
step forward from the earlier mentioned points-based systems.